| 李惠,包洋,黄纯兰.血液科血流感染肺炎克雷伯菌和大肠埃希菌的耐药性及危险因素分析[J].安徽医药,2023,27(3):562-567. |
| 血液科血流感染肺炎克雷伯菌和大肠埃希菌的耐药性及危险因素分析 |
| Drug resistance and risk factor analysis of bloodstream infections caused by Klebsiella pneumoniae and Escherichia coli in Department of Hematology |
| |
| DOI：10.3969/j.issn.1009-6469.2023.03.031 |
| 中文关键词: 肺炎克雷伯菌 大肠埃希菌 β-内酰胺酶类 抗药性，细菌 预后 |
| 英文关键词: Klebsiella pneumoniae Escherichia coli Beta-lactamases Drug resistance, bacterial Prognosis |
| 基金项目: |
|
| 摘要点击次数: 675 |
| 全文下载次数: 206 |
| 中文摘要: |
| 目的 分析血液科血流感染病人产超广谱β-内酰胺酶(ESBLs)大肠埃希菌和肺炎克雷伯菌的耐药性，讨论该类病人的感染危险因素及预后，为合理用药和改善预后提供依据。方法 选取西南医科大学附属医院血液科2018年1月至2021年3月血流感染肺炎克雷伯菌和大肠埃希菌的病人103例为研究对象，按产ESBLs分为产ESBLs组(45例)和非产ESBLs组(58例)，分析其耐药性及感染危险因素；按病人病情转归分为预后不良组(18例)和对照组(85例)，分析预后危险因素。结果103菌株中产ESBLs菌株对碳青霉烯类、阿米卡星、替加环素敏感性较好，其耐药率均低于0.2；对于β内酰胺酶抑制剂的耐药率均低于0.5；对青霉素类、头孢类、氨曲南耐药率大于0.8。与非产ESBL菌株比，产ESBLs菌株对除碳青霉烯类外(亚胺培南、美罗培南)的抗菌药物耐药率较高。年龄≥60岁、有碳青霉烯类抗菌药暴露史、感染前30 d有联合抗真菌药物使用史是产ES?BLs该类菌血流感染的独立影响因素(均P<0.05)；严重性粒细胞缺乏且大于7 d、两种及以上细菌性血流感染、器官功能衰竭、低白蛋白水平是该类病人预后不良的独立危险因素(均P<0.05)。结论 血液科产ESBLs的大肠埃希菌血流感染检出率较肺炎克雷伯菌高；与非产ESBL菌株比，产ESBLs菌株对多数抗菌药物耐药率较高；有碳青霉烯类暴露史或联合抗真菌药物使用史的老年病人感染产ESBLs菌株的风险高；对于多重细菌血流感染及合并器官衰竭病人，需合理评估病人病情，及时纠正粒细胞缺乏、低蛋白血症，改善预后。 |
| 英文摘要: |
| Objective To analyze the drug resistance,infection risk factors and prognosis of bloodstream infections caused by ex?tended-spectrum β-lactamase (ESBLs) Klebsiella pneumoniae and Escherichia coli in Department of Hematology, so as to provide basis for rational use of drugs and improvement of prognosis.Methods A retrospective study was carried on 103 patients who were infected with and Escherichia coli and were admitted to Department of Hematology of The Affiliated Hospital of Southwest Medical University from January 2018 to March 2021. The patients were assigned into producing ESBLs group (n=45) and non-producing ESBLs group (n=58) according to producing ESBLs and an analysis was made of the drug resistance and infection risk factors. The poor prognosis group (n=18) and the control group (n=85) were divided according to disease prognosis to analyze the prognostic risk factors.Results The ESBLs-producing strains of 103 strains were more sensitive to carbapenems, amikacin, and tigecycline, and their resistance rates were all lower than 0.2. The resistance rates to β-lactamase inhibitors were all lower than 0.5, to piperacillin, cephalosporins and aztreonam were greater than 0.8. Compared with non-ESBLs-producing strains, ESBLs-producing strains were resistant to antimicrobial drugs oth?er than carbapenems (imipenem, meropenem). The independent influencing factors for bloodstream infection of producing ESBLs in?cluded age ≥ 60 years old, history of exposure to carbapenem antibacterial drugs, and history of combined antifungal drug use 30 days before infection (all P<0.05). And independent risk factors for poor prognosis in such patients were severe agranulocytosis and greater than 7 days, two or more bacterial bloodstream infections, organ failure, and low albumin levels (all P<0.05).Conclusions The detec?tion rate of ESBLs-producing Escherichia coli bloodstream infections is higher in the Hematology Department that the detection rate of Klebsiella pneumonia bloodstream infections. Compared with non-ESBL-producing strains, the resistance rate of ESBLs-producing strains is higher to most antimicrobial drugs. Elderly patients with a history of carbapenem exposure or use of combined antifungal drugs are at higher risk of infection with ESBLs-producing strains. For patients of multiple bacterial bloodstream infections combined with organ failure, it is vital to rationally evaluate the patients' condition, control agranulocytosis and hypoproteinemia in time, and im?prove the prognosis. |
|
查看全文
查看/发表评论 下载PDF阅读器 |
| 关闭 |
|
|
|
